Gliteritinib Mediated Hypothyroidism Presenting as a Large Pericardial Effusion
Document Type
Article
Abstract
Background: Tyrosine Kinase Inhibitors (TKI) have become an important modality for targeted cancer therapy. These novel agents have improved survivorship and resulted in a growing population of patients on long term TKI therapy. Tyrosine Kinsases play an important role in cellular biology and their complex molecular mechanisms have the potential to mediate both on-target and off-target effects. Thus far TKIs have been implicated in congestive heart failure, QT prolongation, myocardial infarction and pericardial effusions. The cardiotoxic properties of these therapies are only recently becoming better understood.
Case: A 42 year old female with a past medical history significant for Acute Myeloid Leukemia managed on gilteritinib presented with dyspnea, chest pressure, and orthopnea. Physical examination demonstrated diminished heart sounds and periorbital edema. Serum Thyroid Stimulating Hormone was 158 µIU/mL. Electrocardiogram was significant for sinus bradycardia with low voltage QRS. Transthoracic Echocardiography demonstrated a large, non-loculated pericardial effusion with right ventricular diastolic collapse and respirophasic changes in mitral inflow velocities suggestive of tamponade physiology.
Decision-making: Our patient's pericardial effusion occurred secondary to TKI induced hypothyroidism. The patient underwent therapeutic and diagnostic pericardiocentesis due to tenuous hemodynamics and echocardiographic presence of pre-tamponade physiology. 860 mL of serosanguinous fluid was removed without cytological evidence of malignancy. Levothyroxine was initiated for hypothyroidism and close follow up with cardiology and endocrinology was arranged.
Conclusion: TKI therapy has become increasingly important in the treatment of many malignancies. Given the potential for cardiovascular sequelae through both direct and indirect mechanisms, thorough cardiovascular evaluation is critical in patients presenting with cardio-pulmonary symptoms on TKI therapy. The widespread use of these agents and ever-increasing cohort of patients on therapy requires that clinicians across all specialties become familiar with the potential side effect profile of TKIs.
First Page
2912
DOI
10.1016/S0735-1097(20)33539-7
Publication Date
3-24-2024
Recommended Citation
Joshi A, Kurtz E, Lopes R, Sheikh T, Vadhar S, Corotto P. GILTERITINIB MEDIATED HYPOTHYROIDISM PRESENTING AS A LARGE PERICARDIAL EFFUSION. Journal of the American College of Cardiology. 2020 Mar 24;75(11_Supplement_1):2912-.